Vice Says Rehab Doesn’t Work, Alcoholism Isn’t a Disease

I had to be away from the blog for a period of time, and while I was, I saw something I really wanted to respond to.

The libertarian news site Vice ran an interview with the neuroscientist Marc Lewis, who went through rehab for alcoholism himself and applied his experiences to his science know-how (or vice versa).

Lewis’s argument is twofold: that rehab is one big scam and that it’s also dangerous to treat alcoholism as a disease. So, I’d like to address each of these in turn.

Twelve-step scams?

As you know, I’ve been through AA as part of working through my long recovery, which I’ve upheld for two decades now. But that doesn’t mean you’re about to read some rant against Lewis and his criticisms of AA and 12-step programs in general. I agree with some of what he says, just not some of his conclusions.

In the interview, by Neil Sharma, Lewis says that the problem with 12-step programs like AA is that they don’t work after the person leaves, since “they go back to their environments, and all the triggers are there.” Lewis says that people who undergo these programs “don’t get the psychological skills addicts need to move on.”

However, I think that people who go through 12-step programs absolutely do get “psychological skills.” Here’s how I described my experience in an earlier post:

What I liked the most were the things about asking forgiveness for our wrongs and for taking inventory or our flaws and taking responsibility for them. I dived into that whole-heartedly, making lists, checking them twice, contacting a lot of people and righting wrongs, repairing relationships. I spent time inventorying flaws and coming up with methods for addressing them.

So, I think AA did give me “psychological skills.” Once I was no longer in the program, of course, I was the one who had to do the work and I had to exercise the will power. But I of course expected that going in. I’m not sure what else Lewis expects. What sort of magic does Lewis expect from a program, helping a person with no effort on that person’s part?

Where I disagree with him is how he interprets what AA does and how it does it. He seems to be faulting the program for the possibilities of relapse and for the other resources that the addict has to bring into things. But what I don’t understand is: how would not going into rehab be any better? I’ve seen firsthand from many friends that toughing it out, sucking it up, going cold turkey, and just trying to bull one’s way into sobriety is just not successful on any regular basis.

What I’ve found—and I know it’s different for different people—is that sobriety and recovery that leads up to it can be made up of many components. Rather than putting all of one’s chickens in one basket, an addict cobbles together many different positive influences. This can involve sober friends, a significant other, family, religion, a few sage books by philosophers, etc. Take what you can from each and build it into your sobriety. There’s no reason to blow off one particular component for not being a one-stop shop for everything.

Is Alcholism A Disease?

In the last thirty years or so, it’s been pretty commonly accepted that alcoholism is a disease. Lewis strongly disagrees, but he doesn’t offer any medical evidence. He just says that defining it that way just makes addicts “passive” and that their addiction was “learned.”

Now, as with Lewis’s dismissal of AA, I don’t have thin skin about this. I’ll tell you the truth. In terms of my individual, personal experience, I didn’t necessarily think of what I had as a disease. I just didn’t. I thought of it as an addiction. But that doesn’t mean it isn’t a disease.

But let’s look at what the facts say.

In 1991, the American Medical Association classified alcoholism as a disease. The National Institute on Alcohol Abuse and Alcoholism classifies it as a disease. The Kyoto University Bioinformatics Center’s Genome project tells us that essentially, there’s a downgrading of CREB-mediated gene expression, which essentially causes a person to need more pleasure chemicals, and thus turn to drink.

One might say it’s a disease, one caused by behaviors, just as heart disease or cancer could be seen the same way.

If we think of it as a disease, we may then turn to medical treatments. Now, Lewis isn’t a big fan of these either, though he doesn’t say why in a detailed way.

I think that as long as a person takes control of his or her rehabilitation, and as long as consultations with doctors lead to sensible treatments that are monitored closely, one can think of it as a disease or not.

But there’s no reason not to treat addicts with respect. Like in cocaine withdrawal cases. Lewis seems very preoccupied with getting addicts to call themselves lazy or “nasty,” a word he uses. He seems to put a much higher premium on guilt and self-flagellation than I do, based on my experience and the experience of my friends and acquaintances.

It can be the case that while in a long-term dependency on alcohol, a person does some bad things, yes. But I don’t agree with an alcoholic or those around him or her thinking of him or her as a bad person. You didn’t commit a sin by drinking too much—you just made some bad decisions and got into a dangerous excess with real consequences.

Feeling too much guilt and getting into self-loathing will only get in the way of recovery. Ultimately, the kind of toxic negativity Lewis spews is complete clutter to an addict, someone who needs to accentuate positive elements that work and move forward.